Ultimate SOAP Preparation Guide for DO Graduates in Emergency Medicine

Understanding SOAP in the EM Match: What Every DO Graduate Needs to Know

For a DO graduate targeting emergency medicine, the Supplemental Offer and Acceptance Program (SOAP) can be a lifeline—and a major stressor. Whether you’re applying to an emergency medicine residency for the first time, re-entering the Match, or pivoting from another specialty, strong SOAP preparation dramatically improves your chances of landing a position.

This guide is written specifically for the DO graduate in emergency medicine. It explains what SOAP is, how it fits into the EM match landscape, and how to build a step-by-step SOAP preparation plan that you can execute under pressure.

What Is SOAP? (And Why It Matters for DO Graduates in EM)

SOAP (Supplemental Offer and Acceptance Program) is NRMP’s structured process that helps unmatched and partially matched applicants obtain unfilled residency positions in the week of the Main Residency Match.

At a glance:

• When: Monday–Thursday of Match Week
• Who: Applicants who are SOAP-eligible (unmatched or partially matched and registered for the Match)
• What: A series of tightly timed application and offer rounds to unfilled programs
• Goal: Fill unfilled positions and provide unmatched applicants another structured opportunity

SOAP is not the same as “post-Match scramble.” It’s organized, timed, electronic, and heavily rules-based. For a DO graduate interested in emergency medicine residency, SOAP can open doors to EM or related fields (transitional year, prelim internal medicine, family medicine, internal medicine, etc.) that keep you clinically active and competitive.

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The DO Graduate’s Landscape: EM Match Realities and SOAP

EM Match Trends and the DO Graduate Residency Experience

Emergency medicine residency has undergone notable shifts in recent years:

• Increased number of EM residency positions in some cycles
• Greater competition and scrutiny on applicant quality due to workforce concerns
• More DO graduates entering ACGME-accredited EM programs as the single accreditation system has matured

For a DO graduate, this creates both opportunities and challenges:

• Many EM programs are DO-friendly and value osteopathic training, OMM skills, and EM sub-internships at community and academic sites.
• However, EM programs often weigh SLOEs (Standardized Letters of Evaluation), board scores, and clinical performance heavily. Any weakness here may increase the risk of going unmatched.

If you’re approaching SOAP, you likely fall into at least one of the following categories:

• You applied broadly to emergency medicine but did not match.
• You matched into a preliminary or transitional year but not into a categorical EM spot, so you’re partially matched.
• You targeted EM too narrowly, or with application weaknesses (limited SLOEs, lower board scores, late application), and programs passed.

SOAP doesn’t always offer many EM positions; some years there are few or even zero unfilled EM slots. That means SOAP preparation for a DO graduate in emergency medicine must include:

1. A primary plan: pursue any available EM positions.
2. A realistic back-up: consider closely related specialties that keep you on an EM-relevant clinical path.

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Pre–Match Week SOAP Preparation: Building a Strong Safety Net

The best SOAP strategy starts months before Match Week—ideally when you first submit your ERAS application. As a DO graduate focused on EM, you should prepare for SOAP even if you feel confident about your EM match chances; it’s risk management, not pessimism.

1. Know Your Risk Profile for the EM Match

Honest self-assessment clarifies how aggressively you need to prepare.

Key EM-specific factors:

• Board scores (COMLEX and/or USMLE):
  • Below-average COMLEX Level 1/2 or USMLE Step scores? Programs may screen you out.
  • Did you only submit COMLEX without USMLE to programs that historically prefer USMLE?
• Number and quality of SLOEs:
  • 2–3 strong SLOEs from EM rotations at residency sites is a typical expectation.
  • Only one SLOE or generic letters can be a serious liability.
• Breadth of your program list:
  • Did you apply to at least 40–60 EM programs (more if you have academic risk factors)?
  • Did you include a mix of academic, community, and DO-friendly programs?
• Interview volume:
  • Fewer than ~10 EM interviews? Your match risk rises considerably.

If you are in a higher-risk category, you should execute a full SOAP preparation plan early in the application season.

2. Clarify Your Priorities: EM at All Costs vs. EM-Adjacent Path

In SOAP, you must move quickly and decisively.

Be explicit with yourself:

• Is your top priority starting any ACGME-accredited residency in Match Year 1?
• Is your long-term goal still EM, even if that means completing an intern year in another field and reapplying?
• Are you open to another specialty if EM is not realistically attainable?

For many DO graduates who love emergency medicine, a practical hierarchy looks like this:

1. EM categorical position (rare in SOAP, but top priority if available)
2. Transitional year or preliminary medicine/surgery in a setting that supports EM reapplication
3. Categorical internal medicine or family medicine with strong acute care exposure (allowing later EM, EM fellowship opportunities like critical care, or urgent care careers)

Define this hierarchy before Match Week so you’re not making panic-driven decisions.

3. Understand SOAP Logistics and Rules

You must know what is SOAP, how it works, and the rules you can’t afford to break:

• You are SOAP-eligible if:
  • You registered for the NRMP Match
  • You are unmatched or partially matched
  • You are not withdrawn or ineligible for other reasons

Key logistics:

• Monday of Match Week (11 a.m. ET):
  • You learn if you are matched, partially matched, or unmatched.
  • SOAP-eligible applicants gain access to the List of Unfilled Programs.
• Application limits:
  • You can apply to a maximum of 45 programs total during SOAP via ERAS.
• Multiple offer rounds:
  • Programs review applications, conduct fast interviews (often by phone/virtual), and then submit rank lists.
  • You may receive offers in multiple rounds; you can accept only one.
• Once you accept a SOAP offer:
  • You are bound to that program via NRMP rules.
  • You may not continue to pursue other positions in that Match cycle.

You must not contact non-SOAP programs directly, or solicit positions outside the SOAP framework during the active SOAP period. That can result in NRMP violations.

4. Pre-Draft SOAP Documents and Materials

When SOAP starts, you’ll have hours, not days to update documents. Prepare now.

SOAP-Ready Personal Statements

Write at least two versions:

1. EM-focused SOAP personal statement

   • Emphasizes your commitment to emergency medicine
   • Acknowledges growth, reflection on application weaknesses (subtly, without self-sabotage)
   • Highlights DO-specific strengths: holistic care, OMM exposure, adaptability in diverse clinical environments

2. Non-EM/Preliminary/Transitional year personal statement

   • Focuses on being a strong, reliable, teachable intern
   • Emphasizes your interest in acute care, inpatient medicine, procedures, and teamwork
   • Keeps the door open for EM without sounding like you’re using the specialty solely as a stepping stone

Have these reviewed by:

• An EM advisor or clerkship director
• Your school’s career advising office
• A mentor who understands the EM match and SOAP residency dynamics

Curriculum Vitae (CV) Optimization

Update your CV with:

• Any new EM rotations, SLOEs, or letters
• Additional procedural logs or simulation experience
• Leadership in emergency medicine interest groups, EMS, disaster response, or community health

Ensure that:

• Your DO identity (e.g., osteopathic principles, manipulative medicine training) is clearly presented as a value add rather than an afterthought.
• Your CV is formatted cleanly, without errors, and ready to upload or share quickly.

Recommendation Letters and SLOEs

You usually cannot get brand-new letters during SOAP, but you can prepare by:

• Ensuring SLOEs are already uploaded to ERAS well before Match Week.
• Asking your EM mentors if they are willing to:
  • Be available during Match Week for quick advocacy emails or calls (if permitted),
  • Provide updated feedback if a program reaches out.

5. Communication Plan With Advisors and Mentors

Before SOAP:

• Identify 1–2 primary advisors (ideally one EM physician and one dean’s office/career advisor).
• Decide how you’ll communicate during Match Week (text, email, phone) and confirm they’re open to real-time guidance.
• Discuss:
  • Your risk profile
  • Your SOAP strategy tier list (EM > TY/prelim > categorical non-EM)
  • Your realistic competitiveness for EM during SOAP vs. non-EM options

Advisors can help you reinterpret your situation when you see the actual unfilled program list and keep you from making panic-driven choices.

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Executing During Match Week: A Step-by-Step SOAP Strategy for DO EM Applicants

Once Monday of Match Week hits and you learn you’re unmatched or partially matched, there is little time to process emotions. You must move from shock to execution quickly.

Step 1: Pause, Breathe, and Clarify Your Status

When you see you are unmatched or partially matched:

• Take 30–60 minutes to:
  • Breathe, step away, and collect yourself.
  • Reach out to a trusted friend or mentor for support.

Emotional overload can lead to rushed, poor decisions in SOAP. A brief reset improves your judgment for the next four days.

Step 2: Review the Unfilled Program List Strategically

Once the unfilled list becomes available:

1. Identify emergency medicine positions first.

   • Take note of:
     • Geographic location
     • Community vs. academic setting
     • Program size and reputation
     • Whether they’ve historically interviewed or matched DO graduates

2. Next, identify EM-adjacent opportunities:

   • Transitional year programs
   • Preliminary internal medicine or surgery
   • Internal medicine or family medicine programs with strong inpatient and acute care experience

3. Cross-reference each target with:

   • Your board scores
   • Prior communication with the program (if any)
   • DO-friendliness (many programs list DOs in their current or recent residents)

You must build a prioritized list of programs you’ll apply to, within the 45-program SOAP limit.

Step 3: Apply Intentionally Within the 45-Program Cap

Do not scattershot your applications. For a DO graduate focused on emergency medicine residency, consider this type of distribution (adjust based on the actual list):

• If EM positions are available:

  • 10–20 applications to EM programs (if that many exist)
  • 10–20 applications to transitional year/preliminary internal medicine/surgery
  • Remaining to categorical IM/FM at locations and institutions that would support EM or acute care careers later

• If EM positions are scarce or zero:

  • Prioritize transitional year and preliminary programs that are:
    • Attached to EM departments
    • Strong in acute care, ED exposure, and procedures
  • Then fill the remainder with categorical IM/FM where your profile fits.

Coordinate your program selection with your advisors before you submit. A second set of eyes can catch unrealistic targets or missed opportunities.

Step 4: Tailor Personal Statements and Program Messaging Quickly

For SOAP, you may not have time to customize each personal statement per program, but you should tailor them per category:

• EM programs:

  • Use your EM-focused statement.
  • Emphasize your DO strengths in holistic emergency care, adaptability, and resilience.
  • Highlight any strong SLOEs, EM sub-Is, or community ED experiences.

• Transitional/preliminary positions:

  • Emphasize your desire to develop strong foundational skills as an intern.
  • Note your interest in acute care, critical care exposure, and working in high-intensity settings.

• Categorical IM/FM:

  • Frame your interest in comprehensive, continuity, and acute care.
  • Keep your tone respectful; do not imply this is only a “backup” specialty.

Make sure your most updated CV and letters are linked correctly in ERAS when you submit SOAP applications.

Step 5: Prepare for Rapid-Fire SOAP Interviews

Programs often conduct short, focused interviews during SOAP—sometimes 10–20 minutes by phone or video.

For a DO graduate eyeing EM or EM-adjacent roles, rehearse your responses to:

1. “Tell me about yourself.”

   • A 60–90 second summary: DO graduate, EM interest, key strengths, clinical performance.

2. “Why emergency medicine?” (or why this program?)

   • Emphasize specific experiences in the ED: nights, resuscitations, teamwork with nurses and techs, communication with families.
   • Link those experiences to the program’s environment (community, underserved, academic, trauma level, etc.).

3. “Why are you interested in a transitional/prelim/categorical position here?”

   • Show genuine respect for the specialty and program.
   • Emphasize your desire for rigorous training, your commitment to being an excellent intern, and your ability to contribute to their clinical team.

4. “Why do you think you didn’t match?”

   • Take ownership without self-destruction:
     • “I applied somewhat narrowly and had fewer EM interviews than typical. I’ve reflected with my advisors and am working on strengthening my board performance and clinical exposure.”
   • Avoid blaming programs, faculty, or external circumstances excessively.

5. “If you are offered a position here, will you be committed to our program?”

   • If it’s a program or specialty you would truly accept, answer honestly:
     • “Yes, if I receive an offer through SOAP, I would be honored to train here and fully committed to your program.”

Have two or three concise questions ready for each program type, such as:

• For EM or TY/prelim:

  • “How much ED exposure or EM-adjacent experience do interns receive?”
  • “How are interns supported in professional development and mentorship?”

• For IM/FM:

  • “What support do you offer for residents exploring careers in hospitalist medicine, critical care, or urgent care?”

Step 6: Navigating Offers and Decision-Making

During SOAP, offers come in timed rounds. You may:

• Receive no offers in a round
• Receive one offer
• Receive multiple offers (less common, but possible)

You can:

• Accept one offer (which binds you to that position)
• Let it expire (you’ll be considered in later rounds)

For a DO graduate in EM, your choice should balance:

1. Your long-term EM goals
2. The stability of having a residency position this year
3. Program quality and fit

Example decision framework:

• If offered an EM categorical position at a program you consider reasonably supportive:

  • Accept—this aligns directly with your goal.

• If offered a transitional year versus no EM offers yet:

  • Consider:
    • Is this a reputable program that will support EM reapplication?
    • Is the geographic location workable?
  • Often, accepting a solid TY may be wiser than hoping for a highly uncertain late EM offer.

• If offered a categorical IM or FM position and you had no EM or TY offers:

  • Ask yourself:
    • Could I be happy in IM/FM with acute care or hospitalist focus?
    • Does this program allow for flexibility if I later seek EM-adjacent careers?
  • If yes, accepting may prevent a gap year you’re not prepared to optimize.

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After SOAP: Regrouping, Reframing, and Planning Your EM Future

If You Matched Through SOAP

Once you’ve accepted:

• Stop searching for other positions; you are contractually bound.
• Reach out to your new program with a gracious, professional email:
  • Express gratitude and enthusiasm for joining them.
  • Ask about onboarding, schedules, and pre-residency requirements.

If you landed in EM:

• Focus on being an outstanding intern. Your DO background and SOAP journey can become a story of resilience and growth.

If you matched into a TY, prelim, or another specialty:

• Meet early with program leadership to:
  • Clarify expectations
  • Explore ways to strengthen EM-relevant skills (ED rotations, ICU, procedures)
  • Obtain mentorship for possible future EM match or acute care career paths

If You Did Not Match Through SOAP

Not matching after SOAP is emotionally and professionally challenging—but it is not the end of your path.

Next steps:

1. Process the disappointment with support. Talk to advisors, mental health professionals, and trusted peers.
2. Schedule a structured debrief:
   • With an EM advisor and your dean’s office.
   • Review: board scores, SLOEs, interview performance, program list, SOAP applications.
3. Choose a tactical path:
   • A focused gap year building EM/acute care experience (research, ED scribe or advanced clinical roles, additional rotations if available)
   • Strengthen your application: retake/complete USMLE if strategic, bolster SLOEs, publish research or QI projects in EM or critical care.
4. Plan for the next cycle:
   • Apply more broadly
   • Diversify specialties (e.g., include IM or FM from the outset)
   • Address every identified weakness explicitly

For DO graduates, there are many practicing emergency physicians who took non-linear routes to EM, including TYs, other specialties, and late transitions. Your SOAP experience, handled well, can ultimately underline your resilience and commitment.

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FAQs: SOAP Preparation for DO Graduates in Emergency Medicine

1. As a DO graduate, am I at a disadvantage in the EM match and SOAP?
No by default—but context matters. Many EM programs are DO-friendly and have DO faculty and residents. However, some programs historically favor applicants with USMLE scores or those from certain schools. Your main disadvantages are not being DO, but rather any application weaknesses (few SLOEs, low scores, narrow applications). Strong EM rotations, solid SLOEs, and strategic program selection can put you on very competitive footing.

2. How should I prioritize programs in SOAP—chasing EM only or including non-EM?
It depends on the actual number of EM positions available and your risk tolerance. If there are several EM positions and you have a reasonably competitive profile, dedicate a substantial portion of your 45 applications to EM. But always include transitional/prelim and possibly categorical IM/FM slots that fit your long-term goals. Think in tiers:

1. EM, 2) EM-adjacent (TY/prelim), 3) categorical IM/FM with strong acute care.

3. What is SOAP preparation I can start now, even if I hope to match in EM without needing SOAP?
You can:

• Write SOAP-ready personal statements (EM and non-EM versions).
• Update your CV and ensure all SLOEs and letters are uploaded.
• Meet with an EM advisor to review your risk level.
• Learn the SOAP rules and timeline.
• Draft a preliminary list of EM and EM-adjacent programs that have historically been DO-friendly.
  This preparation does not hurt your main EM match effort and gives you a safety net.

4. If I take a transitional or preliminary year, can I still end up in emergency medicine?
Yes, many EM residents have taken indirect routes. A strong TY or prelim year with significant ED, ICU, and acute care exposure can enhance your EM application for the next cycle. You’ll need to:

• Maintain strong clinical evaluations
• Obtain letters from EM and acute care faculty
• Meet early with mentors to plan your reapplication strategy
  While there is no guarantee, many programs respect candidates who’ve performed well as interns and bring maturity and clinical experience to their EM residency.

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SOAP is intense, but with deliberate preparation tailored to your DO background and emergency medicine goals, you can navigate it thoughtfully. Planning now—before Match Week—gives you the best chance to secure a position that keeps you moving toward the EM career you’ve worked so hard to build.